This inspection took place on 12 and 13 November 2018 and was unannounced.

Temple Ewell is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Temple Ewell accommodates up to 44 people in one adapted building. At the time of the inspection there were 41 people receiving nursing care.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We inspected Temple Ewell in October 2017 and the service was rated ‘Requires Improvement’ overall with two breaches of regulation. Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. At this inspection, we found that improvements had been made and the regulations had been met. The service was now rated Good overall.

At the last inspection, we found the registered person had not managed medicines safely and people had not received their medicines as prescribed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, people’s medicines were now managed safely. Systems had been put in place to make sure people received their medicines and these had been effective. Medicine records were now accurate.

At the last inspection, we found the registered person had failed to maintain accurate records in respect of each person. They had failed to act on quality monitoring audits for continuous improvements.

At this inspection, checks and audits to measure the quality of the service had been completed. When shortfalls had been identified, an action plan was put in place and signed off when completed. Records such as care plans were now accurate and reflected the care being given.

Potential risks to people’s health and welfare had been completed, there was detailed guidance for staff to mitigate the risk and keep people safe. Accidents and incidents had been recorded and analysed to identify patterns and trends, action had been taken to reduce the risk of them happening again. Checks had been completed on the environment and equipment to make sure it was safe.

Care plans contained detailed guidance about people’s choices and preferences. Care plans were reviewed regularly and with people where they were able or their representative. People were supported to remain comfortable at the end of their lives.

Staff met with people before they moved to the service to make sure that staff could meet their needs. Staff monitored people’s health and referred them to healthcare professionals when their needs changed. Staff followed the guidance given by health professionals to keep people as healthy as possible. People had access to professionals such as the dentist and optician. People were encouraged to lead as healthy lifestyle as possible, for example, moving in their chair or bed. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in place supported this practice.

People were supported to be as independent as possible and where possible were involved in developing their care and support. People had access to activities they enjoyed and these reflected their interests. People were treated with kindness, staff respected people’s dignity and privacy. People were relaxed in the company of staff and staff understood how to support people when they were anxious.

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The inspection was carried out on 26 and 27 October 2017 and was unannounced on the first day and announced on the second day.

Temple Ewell Nursing Home is a privately owned care home providing nursing care and support to up to 44 adults who have nursing needs and who may also be living with dementia. The rooms are located on two floors, the main entrance is on the first floor accessed by a lift. There are private gardens with seating, patio areas and parking. During the inspection there were 33 people living at the service.

There was a registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 28 February 2017 and Temple Ewell was rated ‘Requires Improvement’ and ‘Inadequate’ in the ‘Safe’ domain. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. We issued a warning notice relating to safe care and treatment. We issued requirement notices relating to good governance, staffing, person centred care and consent. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan to confirm that they now met legal requirements. The provider had met three of the previous breaches, however, there were two continued breaches of regulations. The provider had met the legal requirements of the warning notice.

Previously, risks related to people’s health, care and support had not always been assessed or mitigated. Improvements had been made, there were detailed risk assessments in place for people’s health care needs such as epilepsy. However, there were not personalised risk assessments to provide staff with guidance to keep people’s skin healthy, or how to move people safely.

Previously, care plans had not contained details of people’s choices and preferences. Care plans now contained information about people’s preferences for example, when people liked to get up and go to bed. Each person’s care plan had been reviewed but changes had not always been made to reflect the support being given to the person. Some people’s records were not accurate and there was a risk that staff would not have all the information needed to support people in a person centred way. Staff knew people well and provided support when people needed it.

Medicines had not been consistently ordered, recorded and managed safely at the last inspection. Some improvements had been made, however, there were still shortfalls with the recording of medicines. People had not always received their medicines as prescribed. People’s health was monitored and staff had referred people to healthcare professionals. This had improved since the last inspection. People were supported to eat a balanced diet to remain as healthy as possible.

Improvements to the training and supervision of staff had been made since the last inspection. Staff had received supervision, appraisals and training appropriate to their role including specialist health care training such as diabetes. Staff told us that they felt supported by the provider and management team and they were visible within the service. Staff were recruited safely and there were sufficient staff on duty to meet people’s needs.

At the last inspection, the provider had not been working within the principles of the Mental Capacity Act 2005, improvements had been made. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Applications for DoL

The inspection was carried out on 28 February 2017 and was unannounced.

Temple Ewell Nursing Home is a privately owned care home providing nursing care and support to up to 44 adults who have nursing needs and who may also be living with dementia. The rooms are located on two floors: the main entrance is on the first floor accessed by a lift. There are private gardens with seating, patio areas and parking. On the day of the inspection there were 39 people living at the service.

There was a registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us that they felt safe, however, risk assessments to support people with their mobility, skin care and continence were not detailed enough to show how to manage the risks safely. People were left at risk of not receiving the support they needed to keep them as safe as possible.

The deployment of staff on duty did not ensure that people’s needs were fully met. Records showed that not all staff had received updates in their training. Staff had not received regular one to one supervisions and yearly appraisals to discuss their training needs and professional development.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection there had been no recent applications for DoLS authorisations. Mental capacity assessments had been completed but had not been reviewed since 2015; any changes to people’s capacity had not been assessed and considered in relation to DoLS.

When people were unable to make important decisions for themselves, relatives, doctors and other specialists were involved in their care and treatment and decisions were made in people’s best interests. However, information was not always recorded to confirm how people had given their consent or been involved in decisions that had been made, for example when bed rails were in place to prevent a person getting out of bed.

Care plans did not contain details about people’s choices and preferences. The plans had been reviewed but any changes in people’s care had not been recorded in the care plan. Care plans did not record all the information needed to provide care and support to people in a personalised way. Records were not always completed accurately or properly.

People and relatives told us that staff were caring and respected their privacy and dignity. However, this was sometimes compromised as staff were not always deployed effectively to ensure that people’s care was provided in a timely way to ensure their dignity was maintained. Staff were familiar with people’s likes and dislikes and supported people with their daily routines.

People received their medicines safely. However, medicines were not consistently ordered, recorded and managed safely. People’s health was monitored but it had not always been recognised when other health professionals should be contacted. People were supported to drink and maintain a healthy diet but were not involved in planning the menus.

Accidents and incidents had been recorded and reviewed but further analysis had not been completed to identify any patterns and trends to reduce the risk of them happening again. Checks had been completed on the equipment but there were no environmental risk assessments available on the day of the inspection. The personal emergency and evacuation plan (PEEP) for each person was not detailed enough to inform staff about how to evacuate people safely.

Staff had received safeguarding training and were aware of how to recognise and protect people from harm and abuse. Staff knew about the whistle blowing policy and were confident they could r